Definition

Cirrhosis is a disease in which the liver becomes permanently damaged and the normal structure of the liver is changed. Healthy liver cells are replaced by scarred tissue. The liver is not able to do its normal functions, such as detoxifying harmful substances, purifying blood, and making vital nutrients.

In addition, scarring slows down the normal flow of blood through the liver, causing blood to find alternate pathways. This may result in bleeding blood vessels known as gastric or esophageal varices.

Causes

Causes of cirrhosis include:

• Excessive consumption of alcohol
• Hepatitis C, B, and D
• Autoimmune hepatitis
• Inherited diseases, such as glycogen storage disease, hemochromatosis, or cystic fibrosis
• Genetic conditions such as:
  • Galactosemia
  • Fructose intolerance
  • Tyrosinemia
  • Wilson’s disease
  • Alpha1-antitrypsin deficiency
• Nonalcoholic steatohepatitis (NASH), associated with:
  • Diabetes
  • Obesity
  • Heart disease
  • High blood triglycerides
  • Steroid use
• Bile duct blockages, associated with:
  • Cirrhosis
  • Congenital defects
  • Scarred ducts—sometimes related to inflammatory bowel disorders
  • Gallbladder surgery
  • Pancreatitis
• Drugs and toxins:
  • Arsenic
  • Isoniazid
  • Methotrexate
  • Excess vitamin A
• Infections:
  • Schistosomiasis
  • Brucellosis
  • Echinococcosis
  • Advanced or congenital syphilis
• Heart failure, causing blood to repeatedly back up into the liver

Risk Factors

Factors that may increase your chance of having cirrhosis include:

• Alcohol abuse
• Hepatitis infection
• Liver cancer
• Use of drugs that are toxic to the liver
• Being overweight or gaining weight
• Diabetes that is poorly controlled
• Ingestion of too much iron

Symptoms

Cirrhosis often does not cause symptoms early in the disease process. Symptoms start when the liver begins to fail, as scar tissue replaces healthy cells. Symptom severity depends on the extent of liver damage.

Cirrhosis may cause:

• Fatigue
• Weakness
• Poor appetite, nausea, or weight loss
• Itching
• Abdominal swelling, tenderness, and pain
• Appearance of thin, purplish-red, spidery looking blood vessels on the skin
• Menstrual problems
• Impotence
• Enlarged breasts in men

As cirrhosis progresses, it may cause:

• Yellowing of the skin and whites of the eyes
• Dark urine
• Swelling in the legs and abdomen
• Loss of body hair
• Bleeding and bruising
• Vomiting blood
• Neurological problems, such as forgetfulness, confusion, agitation, or tremors

Complications of cirrhosis may include:

• Ascites —build up of fluid in the abdominal cavity
• Arrhythmias —abnormal heart rhythms
• Sleep disturbances
• Digestive disorders, such as abdominal infections, ulcers, or gallstones
• Liver cancer
• Insulin resistance
• Hypoglycemia
• Coma

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done.

Your bodily fluids may be tested. This can be done with:

• Blood tests
• Liver biopsy

Images may be taken of your bodily structures. This can be done with:

• CT scan
• Ultrasound
• Laparoscopy

Other tests may include:

• Removing fluid from the abdomen and examining it
• Inserting a catheter into the liver vein and measuring the pressure within that vein—rarely necessary
• Other tests to determine what caused the cirrhosis and what complications may occur

Treatment

There is no cure for cirrhosis. The goals of treatment are to keep the condition from getting worse, including:

• Controlling the cause
• Treating underlying medical conditions
• Preventing additional damage
• Treating symptoms and complications
• Having liver cancer screenings

Talk with your doctor about the best treatment plan for you. Options include:

Prevention

To help reduce your chance of developing cirrhosis, take these steps:

• Drink alcohol in moderation. Moderate alcohol intake is no more than two drinks per day for men and one drink per day for women.
• Get hepatitis vaccines.
• Practice safe sex to lower your chance of getting hepatitis B.
• If you use IV drugs, do not share needles. Needles can spread hepatitis B, C, or D.
• Maintain a healthy weight.
• Follow your doctor’s recommendations about blood tests when taking medications that may damage the liver.

American Liver Foundation http://www.liverfoundation.org

Health Canada http://www.hc-sc.gc.ca

Cirrhosis. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at:
http://digestive.niddk.nih.gov/ddiseases/pubs/cirrhosis
Updated April 23, 2014. Accessed September 12, 2014.

Cirrhosis of the liver. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed
Updated June 13, 2014. Accessed September 12, 2014.

Hirschfield GM, Gershwin ME. Primary biliary cirrhosis: one disease with many faces. Isr Med Assoc J. 2011;13(1):55-59.

Molodecky NA, Kareemi H, Parab R, Barkema HW, Quan H, Myers RP, Kaplan GG. Incidence of primary sclerosing cholangitis: a systematic review and meta-analysis. Hepatology. 2011;53(5):1590-1599.

Understanding cirrhosis of the liver. American Gastroenterological Association website. Available at:
http://www.gastro.org/patient-center/digestive-conditions/cirrhosis-of-the-liver
Accessed September 12, 2014.

2/12/2010 DynaMed’s Systematic Literature Surveillance
http://www.ebscohost.com/dynamed:
Chang Y, Ryu S, Sung E, et al. Weight gain within the normal weight range predicts ultrasonographically detected fatty liver in healthy Korean men. Gut. 2009;58(10):1419-1425.